| NPI | 1952664567 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 033344) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CT 007967) |
| Enumeration Date | 2012-06-19 |
| Last Update Date | 2012-06-19 |